The EVAR-1 trial compared endovascular aortic aneurysm repair (EVAR) to open surgical repair for abdominal aortic aneurysm (AAA). Which of the following best summarizes the long-term findings?
- A EVAR had lower 30-day mortality but similar long-term all-cause mortality, with higher rates of reintervention and ongoing surveillance requirement ✓
- B EVAR had lower 30-day mortality and superior long-term survival
- C Open repair had lower 30-day mortality but EVAR had superior long-term outcomes
- D Both techniques had equivalent 30-day and long-term outcomes
Explanation
The EVAR-1 trial found that EVAR had a significantly lower 30-day operative mortality (~1.7%) compared to open repair (~4.7%). However, on long-term follow-up, all-cause mortality was similar between groups, and the early survival advantage of EVAR diminished over time. EVAR was associated with ongoing need for surveillance imaging, higher rates of reintervention (for endoleaks, device migration), and higher rates of late rupture compared to open repair. The graft-related reintervention rate remains higher with EVAR, highlighting the importance of lifelong surveillance.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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